Arthroscopic repair of posterosuperior rotator cuff disorders is a technically demanding but successful procedure. The main keys to success are a combination of proper indication, good technique, and an adequate rehabilitation protocol. The tears should be evaluated for reparability, taking into account personal, anatomical, and biological considerations. If the tear is amenable for repair, arthroscopic rotator cuff repair is considered the gold standard. If the tendons cannot be fully repaired, even a partial repair can be an effective procedure. During the arthroscopic procedure the first step should be to identify the tear pattern and define the repair strategy. Then the surgeon should carefully prepare the footprint and use a repair technique that improves tendon-bone contact. It is essential to obtain a tension-free repair with tendon releases, if necessary. After surgery a rehabilitation protocol designed to protect the healing tendon without causing stiffness is essential. If the tear is considered irreparable, there are many salvage procedures that can be helpful in most patients. Isolated biceps tenotomy, subacromial spacer implantation, superior capsular reconstruction, tendon transfers, and reverse shoulder arthroplasty are alternatives in these challenging patients. Choosing the proper one depends on the tendons affected, the age of the patient, her/his functional requirements, and the degree of arthropathy of the glenohumeral joint.